Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fred David Dodge, LCSW

Individual provider Clinical Social Worker · NPI 1669117438

Fred David Dodge, LCSW is a Clinical Social Worker in Meridian, Idaho. Qualified in 2015, 11 years ago. Practices with Mental Health Specialty Group PA, a 679-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
11
Licensed in
ID
In the registry since
2022
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

2650 S Eagle Rd
Meridian, ID 83642-6725
Phone: (986) 200-4290
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW-40095 (ID)

Record details

NPI number1669117438
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedMay 4, 2022
Last updated in NPPESMay 4, 2022
Certification dateMay 4, 2022
Mailing address2725 Via Valdarno, Pocatello, ID 83201-5830

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Mental Health Specialty Group Pa — 679 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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